Acute fulminant visceral leishmaniasis in children--a report of two cases

Kala-azar usually presents in older children and young adults with insidious onset of fever, splenomegaly and pancytopenia. Characteristic L.D. bodies in bone marrow or splenic aspirates are diagnostic of kala-azar. We report two cases of visceral leishmaniasis in children-1 1/2 and 10 year old with unusual presentation and fulminant course. In case 1 a female presented with fever, jaundice and bleeding manifestations. Peripheral smear revealed L.D. bodies in neutrophils as well as monocytes. The liver function tests were deranged. The child died within three days due to respiratory arrest. Case 2 was a boy who presented with fever and altered sensorium with deranged liver function tests. The patient expired within three days due to hepatic encephalopathy. Thus, it is important to consider the diagnosis of Kala-azar even when the presenting complaints are atypical and institute diagnostic and therapeutic measures early to prevent mortality.